Specialty registrars are public health doctors. They are just like registrars in other medical specialties. They are training to be specialists or consultants in their field. Sometimes they are referred to as public health trainees and were previously known as Specialist Registrars (SpRs) if they had a clinical medical background and Specialist Trainees (SpTs) in Public Health if they did not. Like other registrars, public health registrars train within regional postgraduate medicine and dental deaneries: East of England, East Midlands, Wessex, London, KSS Deanery, Yorkshire and Humber Deanery, Oxford Deanery, South West Deanery, Northern Deanery, North West, Wales and West Midlands. In the UK, specialist accreditation in public health is provided by the Faculty of Public Health (FPH). This accreditation is done through a training programme that is usually five years and consists of sitting examinations to gain membership of the Faculty of Public Health (i.e. Part A and Part B MFPH exams) and working on the training portfolio. This is a list of competencies which all public health trainees should achieve during their training and is assessed annually by a RITA panel. These competencies relate to the ten key areas for public health practice. As of April 2009, there is now an online tool to help registrars compile their evidence to demonstrate that they have completed each competency that has been signed off by their trainers. All competencies must be completed to a satisfactory standard before registrars are allowed to finish their training programme and be awarded a Certificate of Completion of Training. At this point, the registrar can look for a Consultant post either in Public Health or Health Protection.
Like other medical registrars, public health registrars do rotations but instead of rotating around different wards or hospitals, public health trainees work in a variety of settings, such as Primary Care Trusts (PCTs), Public Health Observatories, Department of Health, Health Protection Agency, hospitals, local authorities and in academia. Public health registrars are mentored by Directors of Public health and other consultants, who act as advocates on behalf of the general or local population. Registrars (both medic and non medic) are also expected to do on call, where they are on call one in nine days. This largely comprises of taking notifications of infectious or communicable diseases from other medical professionals and ensuring that steps are taken to prevent close contacts with the infected individual from becoming ill. Sometimes an outbreak or a chemical incident may occur and trainees would work with their 2nd on-call (the consultant) in taking public health action. Depending on previous public health experience, registrars may undertake a Master in Public Health (MPH) in their first year of training and prior to sitting the Part A exam.
The work is essentially a 9 to 5 desk job and involves leading and initiating a number of projects, which have a dual purpose: getting your competencies signed off and helping to improve the health of the local population. The workload varies, depending on the project. Some are discrete pieces of work whilst others involve long term planning and the setting up of systems. The work itself can consist of policy or strategic planning, written reports, presentations to lay audiences, senior management or health professionals, doing evidence based research, teaching at universities or talking to the media.
Check out Public Health Estate Agent for more details on public health placements.
In my fourth year of my training, I spent six months at the Department of Health followed by 3 months at Leeds Primary Care Trust. At the PCT, I worked with the sexual health team in identifying ways to reach their targets for Chlamydia screening. My time at the Department of Health was part of a year long placement. Between July 2007 and January 2008, I led on the development of national guidance on pandemic flu planning for mental health services and for vulnerable groups. This was an interesting piece of project work and required me to spilt my time between Leeds and London, where the pandemic flu team are based. Both guidances involved organisation of consultation groups (stakeholders), workshops, development of audit tools, presentations at the National Pandemic Flu Workshop and of course, writing the guidance! Between January and June 2008, I divided my work between two different areas. Part of my time was spent working on the Framework for Violence and Abuse Prevention, which was launched on Tuesday 25th November 2008, whilst the other half of my work revolved around screening and specialist services. This included conducting a review of the evidence on whether or not to screen for chronic kidney disease, involvement in the implementation of the abdominal aoertic aneurysm (AAA) screening programme and monitoring the diabetic retinopathy screening programme.
Before that, I spent about two and a half years in a Primary Care Trust (PCT) and a 3 month placement at Health Protection Agency. In case you're unfamiliar with Primary Care Trusts, they are the NHS bodies (health authorities) responsible for commissioning health services (e.g. hospitals, GPs) and providing community health services for the public. Each PCT covers a defined geographical area of ~600,000 people and works towards ensuring that the local health services meet the needs of the people. At Calderdale PCT, I had large projects such as leading on the local implementation of the Hepatitis C Action plan, acting as 'Flu Lead' in the PCT and investigating the rise in levels of Vitamin D deficiency in the local population. Smaller projects are so called because they are shorter in time. In August 2006, I led on the local implementation of the changes to the childhood immunisation programme and in December 2006, I produced area profiles of the health needs of the people in Calderdale, to help with the move to Practice Based Commissioning. This was to help the consortia of primary care practices to plan services for their unique populations. For instance, there's no point in setting up excellant family planning services when the majority of your population are elderly!
Medical speciality registrars in public health are paid the same as registrars in hospital settings. Since Agenda for Change, non-medical speciality registrars are paid a similar rate, which is calculated as a percentage of the final point on the NHS 8d salary scale. First year is 45%, second year 47%, third year 49%, fourth year 52% and fifth year 56% of the final point on the 8d NHS salary scale. If your current pay exceeds that of a public health trainee, pay protection is offered. Salary also continues throughout any integrated Master of Public Health course. Both medics and non-medics receive a supplement (~20% of salary) for participating in the local health protection on-call rota.
Information about the specialist training in public health programme can be found at the Faculty of Public Health.
The Public Health Practice Resource Pack is an excellent starting point for those interested in what public health entails.
Another useful source is a www.publichealthy.com, which talks about public health training from the perspective of a specialist registrar.
The selection process is by co-ordinated recruitment process. If you were thinking of joining the public health speciality training programme in 2010, the selection process for England and Wales opened on 4th December 2009 and closed on 18th December 2009. All information including the application process, person specification and the national recruitment timetable is available on the FPH website: Specialise in Public Health - Eligibility and Applications. For information on training posts in Scotland, please visit the MMC Scotland website and for information on training in Northern Ireland see The Northern Ireland Medical and Dental Training Agency website.
If you've passed the written application and assessment tests, then you'll be called for interview at your chosen deanery. Things have changed since I interviewed for the programme but I can give you a rough idea of what to expect. I faced a panel of people, each one had a question and each question was scored. It's important to get one's head around this as it's not like other interviews where there are nice questions asked to get you talking! The main thing to get across is: show that you've had some experience in public health and you're really enthusiastic about working in public health. [So look over your CV and see where your projects or work experience could be repackaged as public health. E.g. say you did a project on improving communication about cancer for a PCT, you could use that to say that your results were fed into the PCT's work on health promotion and your recommendations (e.g. smoking in public places) were taken on board and changes made.] Questions that crop up include "Talk me through your CV" (i.e. what public health experience have you got?); "Have you ever done an audit?" (i.e do you understand the importance of evaluation and outcomes? - i.e. improving patients' health and not just process); "Give me an example of where you were faced with conflict?"; "Give me an example of when you led on a project?" (such questions are to gage whether you have leadership skills and negotiation skills), "why is mental health a public health issue?" and "what do you think I should do to lower the incidence of obesity in my area?".
Be careful of questions that include medical conditions, e.g. HIV. Just have one general sentence like 'HIV is a big problem...' and move onto the crux of the question - are they asking you about prevention? promotion? health protection? services evaulation? Throughout maintain the public health stance of population based, prevention, up stream efforts and evidence based approaches (i.e. objectivity). There are usually some scenario questions like - "You are working on an important report. The deadline is 2 hours and it must be presented to the Board. A phone call comes in and there has been a chemical incident in the town. Three people are dead. What do you do?" This is health protection type question - you can pounce this question off on different people to see what they would say but essentially you need to get the details of the chemical incident (when, where, how, who's there, what chemical involved)) and get it to your Consultant of Communicable Disease Control. The chemical incident is a priority. Another scenario question would be "You're on a local partnership committee for drug misuse. The local policeman, who's the secretary, wants to use some of your funds for binge drinking prevention. How do you stop him from using the resource earmarked for drug misuse?" (this question is a test of leadership skills and facing conflict - public health people lead from behind and keeping people on side is a big part of it!)
There is some reading you can do - the 'Oxford Public Health Handbook' is quite good at helping you understand the managerial and leadership skills you need. Donaldson & Donaldson 'Essential Public Health' is really good for an overall view as is the public health resource pack (I have a link on my hot desk page). Also be familiar with the white paper 'Choosing Health' and its implementation papers. I know it's a few years old but they may ask your opinion on what was included and what was not. (Some criticism was it focused on individual choice when societal structure contributes to health inequalities and prevents people from making healthy decisions). Be aware of the Wanless report -particularly the catchphrase of 'reduce salt, reduce saturated fat, cut out smoking, reduce alcohol intake and exercise'. It can be used to answer a lot of health promotion questions!
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